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Ebola, a Deadly Viral Disease affecting the West
African Country of Sierra Leone
Unisa Seisay
Otterbein University, [email protected]
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Seisay, Unisa, "Ebola, a Deadly Viral Disease affecting the West African Country of Sierra Leone" (2014). MSN Student Scholarship.
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Ebola, a Deadly Viral Disease affecting the West African Country of Sierra Leone
Unisa Seisay RN, BS, MSN Student
Otterbein University, Westerville, Ohio
Introduction
Presently, there has been
an outbreak of Ebola
Virus Disease (EVD) in the
West African countries of
Sierra Leone, Liberia,
Nigeria, Senegal and
Guinea. The outbreak
was first discovered in
Guinea in March 21,
2014 and has spread to
the neighboring
countries. This has
resulted in a lot of
fatalities and is now
considered a global
public health concern
(WHO, 2014).
* Sierra Leone (SL) with
a population of 6 million
people recorded first
case in May, 2014.
As of November 9 ,
2014 according to MHSSierra Leone…
• 4, 435 confirmed
cases.
• 1, 133 confirmed
deaths.
• 897 total survival
and released
patients.
• According to WHO,
outbreak is on the
increased.
Background
SL is unable to
contain the disease.
They lack basic
infrastructures and
personnel to handle
outbreak.
• Fewer
Health/Medical
Amenities
• Fewer Doctors,
Nurses, and other
health care
professionals.
• 5 Laboratories
/testing centers in
whole country.
• One of poorest in the
world & experience a
decade old civil war.
• Lower education rate
& high poverty
• High cultural beliefs
and practices
Signs & Symptoms
Ebola is a virus that causes
high fever and severe
headache, malaise,
vomiting, diarrhea and
abdominal pain.
• 30-50% of patients
shows hemorrhage
symptoms.
• Leads to multiple
organ failures.
• Septic shock & deaths
• 2-21 days Incubation
period, 8 – 10 days
when signs &
symptoms most
visible & transmitted.
• Laboratory testing
done by blood test and
results confirmed in
few days.
• 1 in 5 infections occur
during victim burial &
death (WHO, 2014).
Pathophysiology & Significance
The disease is caused by the virus family Filoviridae and five species have been
identified. The species that has been causing this outbreak in Sierra Leone is the Zaire
ebolavirus. Fruit bats are widely known to be the natural reservoir or host of the Ebola
virus. Ebola is transmitted from human to human through direct contact through bodily
fluids which include blood, semen, urine, stool, sweats or secretions or parenterally
from an infected person or dead body. People also can become infected by direct
contact with the virus through surfaces and contaminated clothing/bedding (Feldmann
et al, 2011 & WHO, 2014). People can be infected by disease through eating infected
animal.
The virus enters the host through broken skin mucosal surfaces. The virus targets
monocytes, macrophages, dendritic cells, endothelial cells, fibroblasts, adrenal corticol
cells, hepatocytes, and other epithelial cells which causes them to replicate and become
infectious. Then, they are transported through the lymphatic system, to the liver and
the spleen via blood. It spreads the infection to different organs and parts of the body.
EVD suppresses the immune system and triggers inflammatory response that inhibits
vascular coagulation which leads to multiple organ dysfunction and death (Fowler et al,
2014, CDC, 2014, & Feldmann et al, 2011).
Treatment/Prevention
There is no
treatment or vaccine
for EVD and
supportive care is the
only option.
• Providing IV fluids.
• Improve Nutrition.
• Maintaining
electrolytes
• Treat other
infections, pain,
and anxiety.
Proper use of PPE,
hand washing and use
of sanitizers or
decontaminate is
essential in controlling.
•
•
Chart showing cumulative death as of November 4, 2012. (WHO, 2014)
A map above from CDC is showing levels of transmission and Ebola treatment Units.
The disease has shown a low level of hemoglobin and hypoxia in a person infected
with the virus. Also, reduced white blood cell (WBC) and platelet counts, proteinuria, and
increased liver enzymes have been found in an infected person. Because of similarities in
symptoms with malaria, typhoid fever and meningitis, Ebola is very difficult to distinguish
with clinical symptoms. Laboratory testing is therefore significant in confirming the
diagnosis of the disease. Laboratory testing for Ebola includes antibody-capture enzymelinked immunosorbent assay (ELISA), antigen-capture detection tests, serum
neutralization test, reverse transcriptase polymerase chain reaction (RT-PCR) assay,
electron microscopy, and virus isolation be cell culture. The incubation period with Ebola
virus is 2 to 21 days and infected individuals cannot transmit the disease until they
develop the symptoms. In Sierra Leone, the most common symptoms with this outbreak
are hemorrhagic fever and gastrointestinal symptoms (nausea, anorexia, abdominal
discomfort). These symptoms are followed by diarrhea and vomiting which then lead to
intravascular depletion and complications. The complications include electrolyte
imbalances, hypoperfusion, disseminated intravascular coagulation (DIC), shock, and
gastrointestinal bleeding (WHO, 2014, Feldmann et al, 2011, & CDC, 2014).
•
•
•
•
•
Problems
SL in state of
emergency.
Many districts and
regions in lockdown
or quarantine.
No schooling & public
gathering
Non-essential
government workers
stay at home.
Economic cost
devastating – people
depend on aid
services.
Human loss
unbearable. Lost of
whole families.
Sense of helplessness.
Implications
Lose of healthcare
workers in SL is
tremendous.
• Lost 4 doctors
including Dr. Sheik
Khan, specialist in
Viral hemorrhagic
fever & Director of
Lassa Fever Center in
Kenema.
• Lost of 7 nurses in a
single treatment
center in Kenema.
• Lost of half the
population in a
Village in Bombali
Conclusion
Speed-up response in
case management,
surveillance & contact
tracing, facilitating
laboratory service,
providing safe burials &
optimizing social
mobilization (WHO,
2014 & Agyepong,
2014)
• Increase in testing
centers.
• Improving burial
time within 24
hours
• Increase number of
healthcare workers.
• Financial and
economic
assistance.
References
Agyepong, I. A. (2014). A systems view
and lessons from the ongoing
Ebola virus disease (EVD)
outbreak in West Africa. Ghana
Medical Journal, 48(3), 168-172.
Center for Disease Control and
Prevention. (2014). Ebola (Ebola
Virus Disease). Retrieved
October, 2014, from
http://www.cdc.gov/vhf/ebola/
about.html.
Feldmann, H., & Geisbert, T. W. (2011).
Ebola haemorrhagic fever. The
Lancet, 377(9768), 849-62.
Fowler, R. A., Fletcher, T., Fischer,
William A., II, Lamontagne, F.,
Jacob, S., Brett-Major, D.,
Bausch, D. (2014). Caring for
critically ill patients with ebola
virus disease: Perspectives from
west Africa. American Journal
of Respiratory and Critical Care
Medicine, 190(7), 733-7
Ministry of Health & Sanitation, Sierra
Leone. Ebola Virus Disease
(EVD) update. Retrieved
November 9, 2014, from
http://health.gov.sl/?page_id=5
54.
World Health Organization. (2014).
Ebola virus disease. Retrieved
November, 2014, from
http://www.who.int/csr/diseas
e/ebola/en/
Additional Sources
Ansumana, R., Bonwitt, J., Stenger, D.
A., & Jacobsen, K. H. (2014).
Ebola in Sierra Leone: A call for
action. The Lancet, 384(9940),
303.
Bagcchi, S. (2014). Ebola haemorrhagic
fever in West Africa. The Lancet
Infectious Diseases, 14(5), 375.
Dixon, M. G., & Schafer, I. J. (2014).
Ebola viral disease outbreak -West Africa, 2014. MMWR:
Morbidity & Mortality Weekly
Report, 63(25), 548-551.
Hayman, D., Yu, M., Crameri, G., Wang,
L., Suu-Ire, R., Wood, J., &
Cunningham, A. (2012). Ebola
virus antibodies in fruit bats,
Ghana, West Africa. Emerging
Infectious Diseases, 18(7), 12071209.
Personal interviews. (2014).